Always Look Behind The Curtain First
I’m a nurse but I’m also human. I have human reactions to humans despite patient and popular perception that, as a nurse, I should be morally, ethically and heroically superior. This misconception along with my facial expressions often gets me into trouble.
“Hey, Nurse Me, can you help me try and start a line?”
“Sure,” I said reflexively.
I’m honored. Someone needs my help and not any someone. A veteran “go to” nurse is having a problem starting an IV and he is asking for my help. Huge ego rush. Huge.
I round the corner with all the excitement of a child at Christmas expecting a cute little bow wrapped puppy under the tree but got dog poo instead. My mouth fell agape, my nose crinkled and my eyes widened becoming fixed on my veteran co-worker in a you’ve-got-to-be-shitting-me stare. None of this is lost on the patient.
“Yes, I know, I’m big.”
Big doesn’t even begin to cover it. This patient is HUGE. His last recorded weight is 722 pounds!
700 and 22 pounds!
That’s beyond huge, that’s gross.
Obesity shouldn’t be an extreme sport.
Now I know that as a nurse I must be prepared to see any and all sorts of anomalies, and I am. I can look at a maggot infested leg wound and not flinch, mainly because I’m not bothered by maggots. I can watch someone vomit without so much as a facial tic as if Nicole Kidman’s esthetician shot me full of Botox. I can pull brains out of someone’s nose without so much as a gag. And I can listen to someone with kidney stones scream in agony as if I am deaf. None of these things bother me.
But face me with someone who could lose 2.5 times the weight of the average man in America and still be obese and I’m beyond bothered.
How do you let yourself get so fat that you can no longer clean 90% of your body? How do you let yourself get so fat that you have no idea what most of your body looks like? How do you let yourself get so fat that brushing your teeth makes you winded? How do you let yourself get so fat that standing is a near impossibility? How do you let yourself get so fat that you can’t even wipe your own ass? HOW DO YOU LET YOURSELF GET SO FAT?
I want a puppy.
Being that fat isn’t healthy. You have diabetes, joint pain, sleep apnea, organomegaly, high cholesterol, shortness of breath and osteoporosis not to mention the odor. The odor that accompanies the schmegma living in the fat folds that your pudgy little hands and arms can’t clean and deschmegmatize.
Our treatment options are limited. We can’t take you to CT Scan should you require it because there’s a weight limit, 400/450 pounds. You won’t fit in an MRI machine, most xrays can’t be done because not even the maximum dose of radiation will penetrate your fat and we (at least at my hospital) will no longer send you to the zoo to have these procedures done because we now consider that inhumane, degrading and embarrassing for you. (This is not a joke; I’ve actually worked at hospitals where our extremely obese patients are sent to the zoo for scans. Dumbo comes of the table, my patient goes on the table.) If my partner and I can’t get an IV, you’ll need a cut down. And that shortness of breath with a ”touch of CHF” you’re experiencing is going to require the insertion of a foley (pee tube). I have no idea how you pee and clean yourself at home but here, in the hospital, we really would like to keep you clean and dry, to reduce your already astronomical risk for infection, specifically Fournier’s. I’ve been there before and NEVER want to go back.
And trust me, I’m far from thrilled about having to insert a foley. It will take a minimum of 7 people: 2-3 people to lift and hold your pannus, 1 person to hold and lift your FUPA (fatty upper penis area), 2 people to hold back your fatty thighs, 1-2 people to apply pressure around your penis to get it to pop out like a turtle’s head and finally 1 person to clean you penis and insert the foley. I think I’d prefer a trip to the zoo. And a puppy. All this is swirling in my mind with my crinkled nose, agape mouth and widened eyes.
I take position on the left side of the bed to look for a vein while making idle conversation.
“Are you having any luck?”
“Mr. Hut, where’s the best place to find a vein?”
“I don’t know.”
“Why did you come to the hosp…,” my mouth froze in mid sentence, the words trapped by my paralyzed vocal cords. From the corner of my right eye, I see something dark move across Hut’s chest. I look up and lock eyes with my partner with a you-just-saw-that, right? expression on my face. From his return stare, he did. And then the patient:
“I’m sorry about that.”
My partner and I remain speechless, not quite sure of the etiquette in this situation. And even before my brain can unfreeze to think of something to say, there it is, the black blur I thought I had seen is now resting on Hut’s right shoulder.
In addition to everything else, Hut has cockroaches living in his fat folds.
I drop my equipment and swiftly exit Hut’s room leaving the veteran behind, quivering and scratching my body as if it were infested with cockroaches. There are 3 things in this world that I have an adverse reaction to and 2 of them just smacked me in the face. I still feel guilty for falling short of my professional responsibilities but sometimes I just have to be human.
Heed my warning young RNs, always look behind the curtain first.